ASHM Report Back

Clinical posts from members and guests of the Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine (ASHM) from various international medical and scientific conferences on HIV, AIDS, viral hepatitis, and sexual health.

Continuing the theme of acknowledging our own societal disadvantages and the urgent need for equity, the Sexual Health Opening Plenary featured Professor Christopher Fairley discussing his own encouraging and inclusive professional ethos.

Key Point: ‘Be nice, but not soft’

Next, Professor Gracelyn Smallwood from Central Queensland University, an Indigenous clinical nurse, midwife, activist, world traveller and ceaseless advocate shared her story. I can’t be the only one there who wished she was my ‘Auntie Grace’, as she unravelled the burden of history currently contributing to growing inequity in our Indigenous, regional and remote communities.

Key Points:

·The disproportionate health burdens existing in ATSI communities are a result of societal breakdown

·Equity will not be achieved until social determinants of health – employment, education, housing – are addressed collaboratively at a policy level, informed by grass roots knowledge

This presentation was a summary of the results of a survey undertaken by a group of GP's , following an increase in requests for labioplasty.

The procedure of labioplasty can vary but in general, involves trimming of the labia minora and possibly trimming of the clitoral hood.

Long term research has not yet been achieved in terms of the long terms effects of this procedure, particularly in relation to post menopausal women.

The presenter indicated that in many women, the labia minora extended beyond the labia majora and was therefore normal but women who sought this surgery believed that they were abnormal. What was often unknown by the women seeking the surgery is that 'more tissue=more sensory availability' .

Psychological drivers for seeking the surgery have often been overlooked, hence the GP survey that was undertaken, with 443 GP completing the survey. Alarmingly 35% of the GP's had experience of this request from women/ girls less than 18 years of age.

Factors that were useful to consider in talking to patients about their concerns were various and included perception of normal versus desirable /influence of pornography/ choice of underwear I.e. G strings and their comfort level and so on.

The take home message is that this surgery appears to be unnecessary for physical reasons in many cases and that the long term effects are unknown.

A/Prof Darren Russell: Complexities of providing prevention tools to a vulnerable population; Lessons from an outbreak in young Indigenous people in FNQ

A look at the rise in HIV cases in Indigenous Australians in Far North QLD with more than 30 cases since 2014. This has come hot on the heels of the local syphilis outbreak in 2011, where over 1000 cases and 5 congenital syphilis cases were reported.

Darren talked about the public health and clinical response, which had to overcome barriers to treatment and engagement. The community and individual cultural and social responsibilities can mean avoidance of care that might cause shame. This is compounded by remoteness, low levels of health literacy, employment, housing, financial and substance issues. Despite being a significant at-risk group, PrEP knowledge and use is scarce.

What stood out is the importance, and the difficulty given history, of building healthy, trusting community relationships. The gap is not yet closed, but in some areas widening.

People from Sub-Saharan Africa and South East Asia have the highest rates of HIV diagnosis in Australia in relation to country of birth, and people are often diagnosed late. Victoria Sande and her colleague Corie Gray presented an engaging talk about a collaborative study which aimed to identify barriers and enablers for testing among these high risk groups.

The study involved focus groups across four states (Western Australia, South Australia, Victoria and New South Wales), and included 77 participants. Questions were centered around HIV knowledge, access and barriers to testing, and ways to increase testing.

Generally, results showed a lack of knowledge in relation to testing across the groups.

Identified barriers to testing included:

·Ideas about why people attend health services. Health services were seen by some as only for those who are sick.

·Some indicated they preferred not to know about an illness which was feared.

·The cost of attending health services.

·Fear of homophobia.

·Participants identified gaps in knowledge about where to get tested.

·HIV was not seen by some as an issue in Australia. They felt that they had been tested on arrival and were therefore in a ‘safe’ country. This was reinforced by the perceived invisibility of HIV in Australia. They did not see much information or concern about it in their surroundings.

·Some older participants had negative experiences of HIV in their country of origin and this impacted on their engagement.

·Fear of having to return to their country of origin if receiving a positive diagnosis.

·HIV was seen by some as associated with people different to themselves, people who engaged in activities such as drug use or sex work.

Some of the motivators for testing were:

·GP initiated testing

·Influence of peers

The presenters suggested that alternative testing methods, including self testing and home testing could be attractive to people from these high risk countries.

HIV testing as part of a regular health check was considered a more acceptable approach, as this did not entail identification as someone at higher risk.

Health promotion targeting the broader community might also be more successful, as opposed to targeted campaigns that these groups do not identify with.

The presentation highlighted the importance of a culturally sensitive approach when encouraging testing for people from these high risk backgrounds.

Psychosocial Complexity in HIV care. Senior Psychologist, Ruth Hennessy presented a snap shot of data from a 65 participant audit collected in 2009 and again in 2016. The audit identified the increasing complexity of psychosocial issues among HIV clients.

The focus of the data identified the increase use of crystal use, increase in social isolation and mental health issues associated with HIV positive clients and thus the importance of a complexity of care model to identify risk. The data also represented the increasing level of clinical comorbidity in clients presenting for psychological therapy at an inner Sydney public health HIV clinic. This increase in comorbidity often equates to an increase in clinical complexity, and the need for an expert interdisciplinary team of clinicians to effectively manage their care in a holistic way.